The American College of Obstetricians and Gynecologists (ACOG) has issued updated recommended guidelines (2019) for identifying preeclampsia in a clinical practice as well as in research protocols. Previous guidelines indicated that PE can be diagnosed if a pregnant woman had high blood pressure and proteinuria. However, many experts have shown that it is possible to have PE without the presence of proteinuria. ACOG no longer considers proteinuria as a necessary sign for diagnosing PE. Instead, the guidelines indicate that healthcare practitioners should look for elevated blood pressure along with proteinuria or one of a number of other complications. Although many healthcare practitioners may still consider PE as mild or severe, the updated ACOG recommendations do not have separate diagnostic criteria for mild and severe PE.
For diagnosing PE, ACOG recommends:
- Systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher occurring on two occasions at least 4 hours apart after 20 weeks of gestation in a woman whose blood pressure has previously been normal
- Systolic blood pressure greater than or equal to 160 mm Hg or a diastolic blood pressure of 110 mm Hg or higher confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy.
- Proteinuria: greater than or equal to 0.3 g (300 mg) per 24 hour urine collection (or this amount extrapolated from a timed collection
- Protein/creatinine ratio greater than or equal to 0.3.
- Dipstick reading of 1+ (used only if other quantitative methods not available)
- In the absence of proteinuria, new onset hypertension with any of the complications listed below.
- Thrombocytopenia: Platelet count less than 100,000/microliter
- Renal Insufficiency: Serum creatinine concentration greater than 1.1 mg/dL or a doubling of the serum creatinine concentration in absence of other renal disease.
- Impaired liver function: Elevated blood levels of liver enzymes to twice normal concentrations
- Pulmonary edema
- Cerebral or visual symptoms